The parallel – and highly interrupted – character of LTACH work poses challenges for where and via which media handoffs are conducted. Many traditional forms of handoffs require ceasing work with patients in order to hand off; however finding the individuals who need to be involved can be challenging at times given the competing demands of clinical work and may necessitate the repetition of handoff information. Furthermore, in some settings the prevalence of interruptions and the need to multitask may challenge the handoff and hinder information flow, potentially compromising patient safety. Thus there has been a question of whether or not handoffs can be conducted by means of written or electronic reports or recorded dictations, or whether a conversation is expected at a given point of transfer and, if so, where and how that conversation is to take place. Telephones, printouts, or tape recordings may be used because shift schedules don’t allow participants to be collocated. If computer-delivered test results or images are to be discussed in a handoff, it may have to occur at a suitable display.
The media by which handoffs may occur have included either a verbal or recorded component or both. Verbal components include face-to-face and telephone conversations, even hybrid forms such as a phone follow-up to either a phone-based recording or face-to face meeting. Recorded components take many possible forms as well, including, informal notes audio recordings formal sign-out documents and official entries in patient medical records and computerized handoff systems. Verbal conversations are important for handoffs because such interactions provide the receiving party an opportunity to clarify information, ask questions, and get immediate answers. Several reports and studies have called for systems that allow ease of access to accurate information to improve handoffs.